Scoliosis
From Marfan Friends World Wiki
Contents |
What is scoliosis?
Scoliosis is an abnormal curvature of the spine to one side. In those who have the condition, the spine bends either to the left or to the right. The bend can occur at any point along the spine, from the top to the bottom. The curvature can also vary from a slight to severe. However, the chest area (thoracic scoliosis) and the lower part of the back (lumbar scoliosis) are the most common regions to be affected
Symptoms
The symptoms of scoliosis in children can include the following:
- one shoulder is higher than the other,
- one shoulder blade is higher and more prominent that the other,
- one hip is more prominent than the other,
- clothes do not hang properly, or
- the child leans to one side.
Diagnosis
Scoliosis is usually diagnosed by having a physical examination of the spine, ribs, hips and shoulders.
The initial diagnosis is often made by a school nurse, or GP, who will then refer your child to an orthopaedic specialist (a doctor who specialises in conditions involving the skeleton, particularly the spine and surrounding joints and ligaments.) The orthopaedic specialist will take an X-ray to confirm the diagnosis. It is also used to determine the shape, direction, location and angle of the curve.
If the curvature of the spine is severe, or if the symptoms of scoliosis are unusual (atypical) for example, you have back pain, a magnetic resonance imaging MRI scan may be taken. MRI scans use sound waves to build up a picture of the inside of your body. These scans can check for any underlying neurological conditions (conditions that affect the nerves).
Treatment
If your child has scoliosis, the treatment they will receive will depend on the extent of the curvature of their spine, their age, and how well their lungs work. There are three treatment options as follows:
- observation,
- bracing, and
- surgery.
Observation
As most cases of scoliosis are not severe, and the condition will often correct itself, as the child grows, treatment is unnecessary. However, X-rays will need to be taken every six months, so that the progress of the curve can be carefully monitored.
Bracing
If the curve of your child's spine is more severe - having an angle of more than 25 degrees - then a brace will be required. The brace cannot cure scoliosis, or correct the curve, but it can stop the curve from getting worse.
The most commonly used brace is known as the Boston Brace. This is a light-weight brace that can be worn under the clothes.
The brace will need to be carefully fitted to your child's spine and, to do this, a cast of your child's spine will need to be taken. This can be done on an out-patient basis. This means that they will not have to spend time overnight in hospital, but instead will have one, or more, appointments at a hospital or clinic.
It is recommended that the brace be worn for 23 hours a day, and that it is only removed for baths and showers. The brace will not interfere with normal everyday activity, and can be worn during most non-contact sports. However, removing the brace for any contact sport is recommended.
'Part-time' braces, that the child only wears for 8-12 hours are also available and are sometimes used when the curvature of the back is minor. However, a number of studies have shown that, in most cases, the longer a brace is worn, the more effective it is.
It is important for children who wear braces to take regular exercise. This will improve muscle tone, body strength, and will make wearing the brace more comfortable.
The brace will have to be worn for as long as your child's body is still growing. Boys typically stop growing around 17 years of age, and girls typically stop growing at around 15 years of age.
Surgery
If your child's scoliosis is severe - their spine has a curve of more than 50 degrees - then they may require surgery. Surgery can prevent damage to the lungs and heart, as well as helping to alleviate back pain and the abnormal development of your child's body.
Spinal fusion surgery is a complicated technique, and should only be carried out by experts in the field. Your child may need to be referred to a specialist unit for surgery.
During surgery, the spine is straightened by using metal hooks and rods, and then fused into place using bone grafts. This technique is known as spinal fusion surgery.
Surgery takes between 4-8 hours. After surgery, your child will be transferred to an intensive care unit, where they will be given intravenous fluid (fluid administered through the vein) and pain relief. Children are normally well enough to leave intensive care after 24 hours, although they will usually need to spend another 7-10 days in the hospital.
Following the operation, most children will be able to return to school 4-6 weeks, and they will be able to play sports about a year after having surgery. Some children may need to wear a back brace to support their spine. However, the brace can normally be removed after six months.
Spinal fusion surgery does carry risks. Therefore, spinal fusion surgery will not be recommended for your child unless the surgeon feels that the benefits outweigh the risks. It is important that both parents, and children, understand the risks of spinal fusion surgery so that they can make an informed decision about treatment.
The known risks of spinal fusion surgery are outlined below.
- Rod displacement - in around 5% of people who have surgery, one of the rods used to straighten the spine will move from its correct position. This should not cause any discomfort, but additional surgery may be required to put the rod back into its correct position.
- Psuedarthrosis - occurs when one, or more, of the bones used to fuse the spine into place fails to graft properly. It happens in around 1-5% cases. It can cause mild discomfort and, in some people, it can also cause some loss of the correction of the curve of the spine. Further surgery will be needed to re-graft the relevant bones.
- Infection - around 1-2% of patients will get an infection after surgery. However, this can usually be easily treated using antibiotics.
- Nerve damage - very rarely (in about 1-2 cases in every 1,000) spinal fusion surgery will cause damage to the nerves in the spine. The results of this nerve damage can be relatively mild (a feeling of numbness in one or both legs), or it can be severe, and cause a loss of all lower bodily functions (paraplegia). In order to minimize this risk, a neurologist (a doctor who specialises in conditions of the nervous system) is always present during spinal fusion surgery, in order to monitor the nerves, and prevent any damage to them.
Alternative therapies
There are a number of alternative therapies that may be helpful in correcting scoliosis. These are outlined below.
- osteopathy (manipulation of the muscles and bones),
- physiotherapy (physical therapy designed to improve general health and well-being)
- reflexology (a therapy that believes massaging certain areas of the body, like the soles of the feet, can improve general health) ,
- acupuncture (a traditional Chinese treatment that involves sticking needles into certain points of the body in order to improve health), and
- the electronic stimulation of nerves in the back.
However, there is no definite evidence that any of these alternative therapies are effective. Physiotherapy can be effective, but only when used in combination with a back brace.
